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Open Access Research article

Variability of physicians’ thresholds for neuroimaging in children with recurrent headache

Carrie Daymont12*, Patrick J McDonald123, Kristy Wittmeier124, Martin H Reed5 and Michael Moffatt126

Author Affiliations

1 Department of Pediatrics and Child Health, The University of Manitoba, Winnipeg, MB, Canada

2 The Manitoba Institute of Child Health, 655A-715 McDermot Avenue, Winnipeg, MB R3E 0Z2, Canada

3 Section of Neurosurgery, The University of Manitoba, Winnipeg, MB, Canada

4 The George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada

5 Department of Radiology, The University of Manitoba, Winnipeg, MB, Canada

6 Department of Community Health Sciences, The University of Manitoba, Winnipeg, MB, Canada

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BMC Pediatrics 2014, 14:162  doi:10.1186/1471-2431-14-162

Published: 23 June 2014

Abstract

Background

We sought to determine the extent to which physicians agree about the appropriate decision threshold for recommending magnetic resonance imaging in a clinical practice guideline for children with recurrent headache.

Methods

We surveyed attending physicians in Canada practicing in community pediatrics, child neurology, pediatric radiology, and pediatric neurosurgery. For children in each of six risk categories, physicians were asked to determine whether they would recommend for or against routine magnetic resonance imaging of the brain in a clinical practice guideline for children with recurrent headache.

Results

Completed surveys were returned by 114 physicians. The proportion recommending routine neuroimaging for each risk group was 100% (50% risk), 99% (10% risk), 93% (4% risk), 54% (1% risk), 25% (0.4% risk), 4% (0.01% risk). Community pediatricians, physicians in practice >15 years, and physicians who believed they ordered neuroimaging less often than peers were less likely to recommend neuroimaging for the 1% risk group (all p < 0.05).

Conclusions

There is no consensus among pediatric specialists regarding the appropriate decision threshold for neuroimaging in a clinical practice guideline for children with recurrent headache. Because of the impact that individual threshold preferences may have on guidelines, these findings support the need for careful composition of guideline committees and consideration of the role of patient and family preferences. Our findings also support the need for transparency in guidelines regarding how evidence was translated into recommendations and how conflicts were resolved.

Keywords:
Risk; Decision threshold; Clinical practice guideline; Medical decision-making; Headache